Week 3: OR-ed Out - Kaminski

This week was similar to the others - I spent tons of time in the CT OR. I am finally getting comfortable with the CT lingo, what tests they order and why, what the results mean, how to identify issues on a TEE, blood pressure monitor, and how they fix them. This in and of itself is really exciting. To be able to really follow a procedure, from multiple view points is so much fun. I'm also just really tired. Although I now have some level of communication with the fellows and doctors I am shadowing, and have been able to ask some more questions, it's not as much as I would have hoped. But more so, I have yet to be exposed to the steps leading someone to having their chest/heart cut open. The clinic was what I was most looking forward to experiencing and that has so far been more or less completely absent. But, I have met some pediatric cardiologists who I think I am going to reach out to and try to follow in the coming weeks.

Last week I saw a lot of pediatric cases which I enjoy much more than the adult cases. The cases of note were a Tetrology of Fallot full repair and a procedure to connect the superior vena cava (SVC) to the pulmonary arteries that seemed to be a modified Glenn Shunt procedure because the child's anatomy was far from normal. The first case had complications, mainly turbidity and non-physiological flow, discovered by the TEE after the pulmonary artery was connected directly to the RV because an outflow tract never developed. The pericardium that had been harvested to make the pulmonary artery wasn't sufficient due to pulling from the PDA and the repositioning to connect the the RV. They had to go back and add a second piece of biomaterial (core matrix) to the site to extend the newly made pulmonary artery. In the second case was the first of a series of two procedures where they would later connect the inferior vena cava to the pulmonary artery to completely bypass the right heart. This kid had a very strange anatomy, the left and right atrium were confused as to their identity, there were two SVCs, and ASD and then a lot of other non-heart related issues. Hopefully the kid will be able to live a normal life, but they are at least lined up for one more major open heart surgery and it sounds like many other surgeries on top of that.

The other interesting case was a man with an aortic root abcess that required the reconstruction of almost his entire left heart. They replaced the mitral and aortic valves and had to rebuild the atrium using a ECM product. This case was not only intense and really interesting (the whole thing was an engineering challenge) but it also brought a new sensation to the OR. The smell of infection and necrotic tissue. Adding to the blood and burning flesh, this really took things to a different level.

In summary, I'm looking forward to getting out of the OR because I think it will help me to appreciate more what happens in the OR - and vice versa! I'm also hoping to observe more in the pediatric floors and will be in the PICU after 4th of July.